Orthopedics:Conditions & Treatments

Hip Preservation

The hip is a very unique joint. It allows us to be very flexible while bearing all of our weight while we walk, run, or jump. The hip works like a ball-and-socket where the upper end of your thigh bone (femur) fits like a ball inside the pelvic socket (acetabulum). In order to work correctly, the ball and socket need to fit together well during all types of movement.

Like all other joints in the body, the hip joint may develop some problems related to development or injury to either the ball or the socket. During the childhood years, pediatric doctors may place the hip back in the socket if it has come out or realign the socket if it is too shallow. Similarly, older patients with arthritis and hip pain are often treated with hip replacements once the smooth hip surface becomes degenerative. Unfortunately many people with hip problems don’t fit into either of these two groups. People in their teens all the way up to their 40’s and 50’s may not be good candidates for hip replacement surgery due to their age and activity level. It is these people who may benefit from hip preservation.

Some of the problems managed by hip preservation include:

Hip pain – the majority of hip problems in teenagers and young adults are minor injuries which may be related to sports. Nonetheless, manyhip dsyplasia serious hip conditions such as hip impingement or hip dysplasia may be misdiagnosed as sprains, strains, or growing pains. Failure to address these problems may result in long term disability.

Hip impingement – Normal hip motion requires a complex relationship between the upper portion of the femur (thigh) bone and the hip socket. Abnormal collision between the hip bone and socket can result in pain, most typically felt in the groin. This can occur in a variety of activities such as sitting for long periods, walking or running long distances, many sports and dancing. This collision can be caused by a misshaped femur bone or hip socket, or even a combination of the two. Our specialists are trained in caring for children and adults with hip impingement using a variety of both nonsurgical and surgical techniques.

Hip dysplasia – The hip socket is designed to hold the femur tightly to prevent it from coming out of the socket while allowing enough motion to permit a wide variety of activities. The hip socket may not develop normally, a condition known as hip dysplasia. If left untreated, many patients with hip dysplasia will progress to arthritis in their 30’s or 40’s, if not before. Hip arthritis is a debilitating condition and is usually treated with a joint replacement. Our providers have extensive experience in treating patients of all ages with hip dysplasia. The majority of patients with hip dysplasia are treated with surgical procedures including the periacetabular osteotomy (PAO) or Ganz osteotomy. This procedure, only performed by a small handful of physicians in Georgia, offers the ability to correct hip dysplasia and potentially avoid the need for a hip replacement. This exciting treatment has offered patients with hip dysplasia a hope for returning to normal activities.

Slipped epiphysis – patients with slipped epiphysis or SCFE typically develop this condition during the early teenage years however its effectsslipped capital femoral epiphysis may last longer. Many patients with SCFE have hip and groin pain in addition to stiffness and less motion in their hips which affects their ability to perform certain tasks or activities. Children with SCFE may require surgical treatments to reduce their pain and increase the motion and function in the hip. Emory orthopaedists are specially trained in treating these conditions through techniques, ranging from hip arthroscopy to hip osteotomies and surgical hip dislocation (SDH).

Perthes disease – Patients with Perthes disease, a condition which also begin developing symptoms in the first decade of life, often around the age of 6-8 years old. Perthes invariably causes long term hip problems, although some patients develop pain in their teens and twenties while others are asymptomatic until their 50’s or 60’s. Emory’s unique ability to care for patients of all ages, from the first decade of life until old age allows patients to have a life-long partner in their hip care.

Treatment

Hip preservation involves a variety of mostly surgical techniques designed to allow you to keep your hip when activity modification or therapy is not beneficial. This can range from minimally invasive hip arthroscopy to more complex femoral osteotomies or periacetabular (Ganz) osteotomies around the hip. These procedures are used to realign, reconstruct, and hopefully extend the life of a painful, problematic hip.

At Emory Orthopaedics & Spine Center, we have a pediatric orthopedic hip specialist, an adult hip reconstruction surgeon, and a surgeon with expertise in hip arthroscopy. By combining these specialists, patients are able to benefit from life-long care of their hips rather than seeing a physician only specializing in pediatrics, hip arthroscopy, or hip replacements. This multimodal life-long hip care model is the only one of its kind in Georgia.

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